A quick demonstration: Cover one ear with the palm of your hand and hum. In all likelihood, the humming will sound louder in the covered ear. The reason is that your hand is blocking sound from outside your body, causing the internal sound of your humming to be perceived as louder.
That was a demonstration of the basic principle behind the Weber test, named after the 19th century physician Ernst Heinrich Weber. It is generally used to detect unilateral conductive hearing loss. The examiner places a vibrating tuning fork in the center of the patient’s head. The patient is asked whether or not the sound is louder on one side.
In conductive hearing loss, the sound will be louder in the involved ear, just like the sound of your humming was louder in your covered ear. The conductive hearing loss masks environmental noise, making it easier to perceive the tuning fork sound through bone conduction. Common causes of conductive hearing loss include earwax, otitis media, sinusitis, damage to the tympanic membrane, and damage or dysfunction of the Eustachian tube.
This simple test can be surprisingly sensitive. At least one source maintains that a difference in acuity as small as 5 decibels can be detected with the Weber test.1
The Weber Test as a Chiropractic Outcome Measure
The plausibility of D.D. Palmer’s experience with Harvey Lillard is based on the neuroanatomy of the middle and inner ear.2 The sympathetic nerve supply to the middle and inner ear includes presynaptic contributions from T1 to T5, and postsynaptic contributions from the cervical spine. The patency of the Eustachian tube depends on normal function of the soft palate muscles, which are largely controlled by the vagus and trigeminal nerves. Thoracic and cervical subluxation, along with cranial faults, are well-positioned to contribute to conductive hearing loss due to their influence on the above-mentioned spinal and cranial nerves.
It follows that chiropractic adjustments could contribute to alleviation of conductive hearing loss. Therefore, while the Weber test was developed for the otologic examination, it plausibly offers “off-label” use as a chiropractic outcome measure.
Real-Life Example: A 35-year-old technical support worker and bass guitar player had a previous history of neck pain. He attributed a previous injury to having a bit of “irrational exuberance” during a performance, swinging his guitar wildly up and down. Two years after his initial visit, he reported neck pain of several days’ duration, as well as “ear popping.”
On the Weber test, he reported the sound was louder on the right. Subluxation signs on physical examination clustered around C1, the first rib, C5, and a thoracic anteriority, all of which were adjusted. On follow-up six days later, he reported a 50% reduction in neck pain and alleviation of ear popping. The Weber test was negative.
Published Example: A 58-year-old real-estate agent with long COVID symptoms was discussed in a 2022 paper.3 Among her symptoms were disturbances in the sense of smell – hyposmia and parosmia. After she mentioned that her sense of smell was better in her left nostril than her right, we surmised that nasal congestion could be aggravating her COVID-related olfactory loss.
On Weber testing, the sound of the tuning fork was louder on the right. Intervention included cervical, thoracic, and sacroiliac adjustments. At her fourth visit, she reported that her sense of smell was slightly improved. The Weber test was negative.
The Weber Test as Part of the Chiropractic Analysis
There is already an abundance of outcome measures available to the practitioner. While adding the Weber test to this assessment toolbelt is good, what would be even better is a way to use the test to point out a motion segment that needs attention. The following experience indicates this may be possible.
Real-Life Example: A 64-year-old retired sales executive presented with episodes of temporomandibular (TMJ) discomfort and headache during the previous six weeks. Adjustments included upper cervical and TMJ corrections. On follow-up six days later, she reported 50% relief from the TMJ discomfort, but now complained that her left ear felt “plugged up.” The Weber test was positive on the left. The test became negative when done with the patient in left cervical rotation.
This suggested upper cervical involvement in the ear congestion. Adjustments included correction of the left C1-C2 motion segment, the TMJ, and soft-tissue reflex work for the neck flexors. After the adjustment, the patient expressed surprise, stating she could feel her ear congestion breaking up. This comment was unprompted. The Weber test was now negative. There was no further follow-up due to the patient’s busy schedule.
Build Our Evidence-Base
The Weber test is a well-established and well-understood procedure in health care. Published accounts of its utility in chiropractic assessment are desirable. Assistance with preparing a case report for publication is readily available from the research department of your chiropractic alma mater or from yours truly.
References
- Souza TA. Differential Diagnosis for the Chiropractor: Protocols and Algorithms. Gaithersburg, MD: Aspen Publishers, 1997: p. 686
- Homewood AE. The Neurodynamics of Vertebral Subluxation. St. Petersburg, FL: Valkyrie Press, 1977: pp. 215, 252-53.
- Masarsky CS, Todres-Masarsky M. Long COVID hyposmia/parosmia and subluxation: a case report. Asia-Pac Chiropr J, 2022;3:2. Full text: Read Here.
